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| CLINICAL RECORDS |
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| Year : 2004 | Volume
: 6
| Issue : 1 | Page : 16-18 |
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Unusual case of minor salivary gland tumour
Abdulrahman Al-Sanosi
Department of ORL-HNS, King Abdulaziz University Hospital, Riyadh, Saudi Arabia
| Date of Web Publication | 12-Jul-2020 |
Correspondence Address:
MD Abdulrahman Al-Sanosi
Department of ORL-HNS King Abdulaziz University Hospital P.O. Box 245, Riyadh 11411
Saudi Arabia
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/1319-8491.289579
Acinic cell carcinoma occurs most commonly in major salivary glands. Minor salivary glands involvement is uncommon. A review of English literature revealed bout 80 previously reported cases. Here we report a 52-year old Saudi male patient who presented with an ulcerated soft palate mass. Histopathological examination revealed the tumour to be acinic cell carcinoma. The clinical, histopathological features as well as management will be discussed.
Keywords: soft palate mass, minor salivary gland tumours, acinic cell carcinoma
How to cite this article:
Al-Sanosi A. Unusual case of minor salivary gland tumour. Saudi J Otorhinolaryngol Head Neck Surg 2004;6:16-8 |
| Introduction | |  |
Salivary gland tumours are uncommon head and neck neoplasm [1], Neoplasms of minor salivary glands account only for 10-15% of all salivary gland neoplasms [2].
Minor salivary gland tumours are found most commonly in the oral cavity with the palate being the most common area involved followed by the buccal mucosa and retromolar fossa [2]. Pleomorphic adenoma is the most common benign minor salivary tumour and mucoepi- dermoid carcinoma is the most common malignant minor salivary tumour [2].
Acinic cell carcinoma of minor salivary glands is exceptional. Relatively , few cases have been described in the literature. Most of the information we know about this type of tumour have been obtained from studies of acinic cell carcinoma occurring in major salivary glands [3].
The first description of this tumour was made by Nasse in 1892 who considered it to be benign. The description of the malignant behaviour of this tumour is accredited to Buxton and Goldwin in the early 1950s [4].
We present an unusual case of acinic cell carcinoma of the soft palate in a Saudi male with the aim that it will be added to the number of cases reported in the English literature.
| Case report | | |
A 52-year old Saudi male patient not known to have any medical illness presented to the ORL clinic of King Abdulaziz University Hospital, Riyadh, Saudi Arabia in May 2002 with an ulcerated and fungating mass of the soft palate. The mass has been there for about one year and progressively increased in size over the last three months. It was asymptomatic except for occasional presence of blood stained saliva. There was no history of sore throat, dysphagia , regurgitation or speech defects. The patient was a smoker for twenty years although he stopped smoking ten years ago.
On examination an ulcerated mass measuring 3x3 cm involving the soft and hard palate and the upper part of the right tonsil was seen which bled to touch [Figure 1]. There were no masses or enlarged lymph nodes on neck examination and the rest of ENT examination was within normal. | Figure 1: The ulcerated mass measuring 3×3 involving soft and hard palate and upper part of right tonsil.
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Routine laboratory work up was normal. Chest x-ray and ultrasonography of the abdomen was also normal. CT scan of the neck region was performed revealing a right retromolar trigone mass with heterogeneous enhancement causing oropharyngeal narrowing and bony destruction of the medial side of the right mandible [Figure 2]. A lymph node measuring lxl cm was also seen in the right diagstric area. Biopsy taken under local anaesthesia revealed sheaths like proliferation of cells moderate in size with round, uniform appearing nuclei. These nuclei were surrounded by an amount of cytoplasm full of basophilic granules. Occasional intercalated duct like duct structures were seen. The appearance were features of acinic cell carcinoma [Figure 3]. | Figure 2: CT scan of neek showing right retomollar trigon with heterogeneous enchancemen, the mass causing oropharyngeal narrowing, bony destruction of medical side of right mandible and 1 × 1 cm lymph node noted on right digastric area.
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The patient was referred to the King Faisal Specialist Hospital in Riyadh upon his request where he underwent partial palatectomy with resection of the right tonsils and part of the buccal mucosa. The neck was treated with right supraomohyoid neck dissection. The patient was followed up in the speech pathology and radiation oncology clinics.
| Discussion | | |
The anatomical distribution of minor salivary gland tumours include the palate, buccal mucosa and lips which are the most predominant sites [2]. Our case described here involved the soft palate. About 53% of minor salivary gland tumours occur in the palate and 65% of them are malignant [2], Pleomorphic adenoma is the most common benign minor salivary gland tumour and mucoepidermoid carcinoma is the most common malignant tumour [2], Age range is 3-90 years with an average of 44 years and peak in the 5th decade.
The occurrence of acinic cell carcinoma in minor salivary glands seems to be exceptional and that is reason that led us to report this case. We hope to draw the attention of physicians to consider this kind of tumour in this unlikely location in the differential diagnosis.
The Armed Forces Institute of Pathology registry shows that 116 (13.1%) cases out of 886 cases of minor salivary gland tumours were acinic cell carcinoma and only in 22 (2.5%) of them was the palate involved[5],[6].
Spiro et al, 1978,m [3] reviewed 570 cases of minor salivary gland tumours seen at the Memorial Sloan Kettering Canccr Center from 1939-1968 and found only two cases of acinic cell carcinoma. Batsakis et al,1979,[7], described a classification of low and High grade malignancy.
Histopathological features of acinic cell carcinoma in minor salivary glands is not different form that of major salivary glands where the tumour is histologically divided into 4 categories: solid growth, microcystic, papillary cystic, and follicular. The predominant variant is the solid growth type [6],[8]. Our case was of this type.
Acinic cell carcinoma is a malignant tumour with a tendency to recur and metastasize [4].
Surgery was employed as the primary form of treatment in our patient and surgery is considered to be the mainstay of treatment. Complete removal of the neoplasm at the time of initial surgical intervention is the recommended therapeutic option. On the other hand , incomplete removal is associated with a high rate of local recurrence [9], Poor prognostic factors also include histological grade of the tumour, size and positive margins. Although, clinically no palpable lymph nodes were felt in the neck of our patient, CT scan revealed a lymph on the right side and accordingly a right supraomohyoid neck dissection was carried out.
Post-operative radiotherapy is indicated for high grade tumours, positive margins, perineural invasion, and multiple positive lymph nodes [10], In our case there was neither positive margin nor perineural invasion. Metastasis to cervical lymph nodes seems to occur early within 5 years while distant metastasis appear late [7],
Acknowledgment
I would like to thank Dr. Abdulrahman Al-Fayez from the King Fahad National Guard Hospital in Riyadh for allowing me to report this case. I would also like to express my appreciation to Prof. Yousry Al-Sayed from the Department of Otolaryngology, King Saud University, Riyadh for his generous support and help in revising this manuscript.
| References | | |
| 1. | Leegaard T, Lindman H. Salivary gland tumours:clinical picture and treatment. Act Otolaryngol 1970;263:155-159.  |
| 2. | Jansisyanont P, Blancharet THjr, Ord RA. Intraoral minor salivary gland neoplasms: a single institution experience of 80 cases. Inl J Oral Maxillofac Surg 2002;31:257-261. |
| 3. | Spiro RH, Huvos AG, Strong EW. Acinic cell carcinoma of salivary origin. A clinicopathologic study of 67 cases. Cancer 1978;41:924-935. |
| 4. | Zbaeren P,Lemann W,Widgren S. Acinic cell carcinoma of minor salivary gland origin. J Laryngol Otol 1991;105:782-785. |
| 5. | Ellis GL, Auclair PL, Gnepp DR. Surgical pathology of the salivary glands. Philadelphia, PA: WB Saunders CA, pp.299-317,1991. |
| 6. | Eilis GL,Auclair PL. Tumours of salivary glands in: Atlas of Tumour Pathology., vol 3. Washington. DC; Armed Forces Institute of Pathology 1995;17:183-203. |
| 7. | Batsakis JG,Chinn EK, Weimert TA,Work WP, Krause CJ. Acinic cell carcinoma: a clinicopathologic study of thirty five case. J Laryngoll Otol 1979;93:325-340. |
| 8. | Seifert G. Histological typing of salivary gland tumours.2nd ed. New York,NY:Springer-VerlagNY Inc;pp. 17-19,1991. |
| 9. | Lewis JE, Oslen KD, Weiland LH. Acinic cell carcinoma ;Clinicopathological review. Cancer 1991;67:172-179. |
| 10. | Carrat F et al. Vallecular acinic cell carcinoma in a 9-year old girhreport of unusual case. Int Pediatr Otolaryngol 2000;52:61-64. |
[Figure 1], [Figure 2], [Figure 3]
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